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General NPI Number Information
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NPI Number | 1952731390
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Entity Type | Organization
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Legal Business Name | JOHN M MCCLUSKEY MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 340 4TH AVE SUITE # 8A
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City | CHULA VISTA
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State | CA
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Zip | 91910-3813
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Country | US
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Telephone | 619-422-0386
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Fax | 619-422-0474
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Provider Business Mailing Address
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Address Line | 340 4TH AVE STE 8A
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City | CHULA VISTA
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State | CA
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Zip | 91910-3813
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Country | US
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Telephone | 619-422-0386
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Fax | 619-422-0474
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MICHAEL MCCLUSKEY
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Credential | M.D.
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Telephone | 619-422-0386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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